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This Month in Archives of Neurology
July 2008

This Month in Archives of Neurology

Arch Neurol. 2008;65(7):871-872. doi:10.1001/archneur.65.7.871
Predicting Therapy for Glioblastoma

Colman and AldapeArticle identified 3 distinct molecular groups of glioblastoma (GBM) called proneural, proliferative, and mesenchymal, based on the pattern of genes with the highest expression in each cluster. These data demonstrate that robust molecular subtypes of GBM can be identified across independent data sets using gene expression profiles, and that the mesenchymal/angiogenic phenotype may represent the majority of aggressive newly diagnosed and recurrent GBM tumors. These molecular data will be of considerable value to neurooncologists in individualizing therapy for specific patients.

Aquaporin-4 Antibodies in Neuromyelitis Optica and Longitudinally Extensive Transverse Myelitis

Waters and colleaguesArticle have developed a clinically applicable quantitative assay to detect the presence of aquaporin-4 (AQP4) antibodies in patients with neuromyelitis optica and to characterize the anti-AQP4 antibodies. They point out that further studies on larger samples will be needed to show if their novel and highly sensitive quantitative fluorescence immunoprecipitation assay is suitable for clinical use.

Cognitive Function Over Time: Value of Nonsteroidal, Anti-inflammatory Drugs

The ADAPT Research GroupArticle conducted a randomized, double-masked chemoprevention trial to evaluate the effects of naproxen and celecoxib on cognitive function in older adults. Prior observational studies have shown a reduced risk of Alzheimer dementia in users of nonsteroidal anti-inflammatory drugs. They report that the use of naproxen or celecoxib did not improve cognitive function and suggest they should not be used for the prevention of Alzheimer dementia.

Mean global summary scores over time by treatment group (baseline, N = 2528; year 1, n = 2088; year 2, n = 1485; year 3, n = 700).

Mean global summary scores over time by treatment group (baseline, N = 2528; year 1, n = 2088; year 2, n = 1485; year 3, n = 700).

Rural and Urban Differences in Acute Stroke Practices

Leira and colleaguesArticle believe the existing gap between stroke care in urban and rural areas may widen in the future as more urban-tested interventions are incorporated into the treatment of acute stroke. They review the problems and potential solutions that exist in 3 aspects of the current treatment system for stroke in rural areas: prehospital care, local hospital emergency department care, and interhospital transfer of patients. They provide views on these issues that indicate that the current differences between rural and urban treatment practices for stroke could be overcome.

Distinct Pools of Amyloid β in the Brains of Patients With Alzheimer Disease

Steinerman et alArticle segregated amyloid β (Aβ) from the brains of patients with Alzheimer disease (AD) into distinct biochemical pools that may be enriched in biologically relevant forms of Aβ, to determine if specific forms of Aβ may differentially correlate with clinical features. Interestingly, they find that intracellular and membrane-associated Aβ, especially Aβ42 in the temporal neocortex, was more closely associated with AD symptoms than other measured Aβ species.

Optical Coherence Tomography in Neuromyelitis Optica

In their study, de Seze et alArticle find that optical coherence tomography (OCT) results are significantly altered in patients with neuromyelitis optica. The technique is easy to perform, and the results are well correlated with visual acuity and visual field. They state that it could be considered as a marker of axonal loss, as they found a strong correlation between OCT and the Expanded Disability Status Scale.

Optical Coherence Tomography and Evidence of Axonal Degeneration in Multiple Sclerosis

Zaveri et alArticle report that optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDx) are noninvasive ocular imaging modalities that measure retinal nerve fiber layer (RNFL) thickness. They find that GDx measurements of RNFL thickness corroborate OCT evidence of visual pathway axonal loss in multiple sclerosis. Their data support the validity of RNFL thickness as a marker for axonal degeneration.

Predictors of Extubation Failure in Myasthenic Crisis

Seneviratne and colleaguesArticle assessed the risk of extubation failure in myasthenic crisis and identify predictors of extubation failure. Male sex, history of previous crisis, atelectasis, and intubation for more than 10 days were associated with extubation failure. Atelectasis showed the strongest association with this complication.

Renal Glomerular Function and Risk of Stroke

In this study, OvbiageleArticle validated clinical measurements of impairment in glomerular barrier and filtration rate and determined their relationship to stroke. Microalbuminuria, decreased glomerular filtration rate, and stage 3 chronic kidney disease were significantly associated with stroke.

Loss-of-Function Leucine-Rich, Glioma-Inactivated 1 Mutation and Dominantly Inherited Temporal Lobe Epilepsy

Striano et alArticle describe the clinical and genetic findings in a family with autosomal dominant lateral temporal epilepsy to determine the functional effects of a novel leucine-rich, glioma-inactivated 1 (LGI1) mutation in cultured cells. They report that the mutant LGI1 protein was not secreted by cells in culture. These data provide direct evidence that LGI1 mutations result in loss of secretion of the mutant protein, preventing interaction with its specific postsynaptic receptor, ADAM22, resulting in epilepsy.

A Novel Locus for Generalized Epilepsy With Febrile Seizures Plus Maps to Chromosome 8p23-p21

Baulac and colleaguesArticle show by linkage analysis that generalized epilepsy with febrile seizures plus (GEFS+) maps in a large family with 11 affected members to a locus on chromosome 8p23-p21 with a logarithm of odds score of 3.0. As no ion channel genes are located at this site, identification of the responsible gene will probably uncover a new mechanism of pathogenesis of GEFS+.

Pallidal and Thalamic Stimulation in Tourette Syndrome

Welter and colleaguesArticle show that high-frequency stimulation of the associative-limbic relay within the basal ganglia circuitry may be an effective treatment for patients with Tourette syndrome, as there was a dramatic improvement in tic severity.

Ataxia and Oculomotor Apraxia Type 2

Anheim et alArticle describe 7 patients from 4 families with clinical features of ataxia with oculomotor apraxia type 2, and identified 3 novel senataxin gene (SETX) mutations.

Mini-Mental State Examination in Highly Educated Individuals

O’Bryant and colleaguesArticle provide comprehensive data in support of the view that older patients with a college education who present with complaints of cognitive decline and score less than 27 on the Mini-Mental State Examination are at a greater risk of being diagnosed with dementia and should be referred for a comprehensive dementia evaluation, including formal neuropsychological testing.

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